The mammalian vessel system includes a number of subdivision systems; circulatory, lymph, gastrointestinal tract and urinary system.
The circulatory system is an organ system that passes nutrients (such as amino acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body to help fight diseases and help stabilize body temperature and pH to maintain homeostasis. The circulatory system may be defined as a blood distribution network, but may be considered as composed of the cardiovascular system, which distributes blood, and the lymphatic system, which distributes lymph. While humans, as well as other vertebrates, have a closed cardiovascular system; some invertebrate groups have an open cardiovascular system.
Two types of fluids move through the circulatory system: blood and lymph. The blood, heart, and blood vessels are components of the cardiovascular system. The lymph, lymph nodes, and lymph vessels are components of the lymphatic system. The cardiovascular system and the lymphatic system collectively make up the circulatory system.
The gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. (The “digestive system” is a broader term that includes other structures, including the accessory organs of digestion). The tract may also be divided into foregut, midgut, and hindgut, reflecting the embryological origin of each segment of the tract. The GI tract discharges hormones as to help control the digestion process. These hormones, including gastrin, secretin, cholecystokinin, and grehlin, are mediated through either intracrine or autocrine mechanisms, distinguishing that the cells releasing these hormones are conserved structures throughout evolution.
One of the main organs of the urinary system is the kidney. This is important because the kidneys' main role is to filter water-soluble waste products from the blood. The other attachment of the kidneys is at their functional endpoints the ureters, which lies more medial and runs down to the trigone of urinary bladder.
The systems of vessels in the body are important in that, among other functions, they remove toxins from the body and distribute important materials to vital areas of the body. When vessels become blocked or restricted, major problems may occur. For example, a blockage (or partial blockage) of a coronary artery may lead to coronary infarction, a blockage (or partial blockage) of a ureter may lead to kidney damage, a blockage (or partial blockage) of a cerebral vessel may cause a stroke, etc.
Angioplasty surgery has been performed for many years; the accepted surgical procedure of clearing arteries or veins by the use of drugs and devices has been constantly refined. Even so, the fatality rates for patients enduring the surgery still have serious consequences. One reason for the high fatality rate is that the procedure presents a significant surgical endeavor, making it enormously discretionary in-patients with severe coronary problems, in poor health or very old.
With regard to angioplasty, there are currently many different types of medical devices and techniques that are used to perform angioplasty procedures. These devices may include elements such as: tubes, wires, miniaturized devices, devices with heaters, devices with optical fibers, laser energy, rings catheters, balloons, etc. Angioplasty has come to include all customs of vascular interventions typically performed in a minimally invasive or percutaneous environment.
Prior art related to angioplasty include procedures utilizing empty and collapsed balloons on a guide wire, known as a balloon catheter. This type of device is passed into a narrowed location of a vessel and then inflated to an expanded size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). Upon expanding, the balloon crushes the features causing the narrowing (e.g., fatty deposits, plaque), thereby opening up the blood vessel for improved flow, and the balloon is then collapsed and withdrawn.
U.S. Pat. No. 4,650,466 to Luther describes an angioplasty device inclusive of a woven tube of metal or plastic fibers and a retraction stylet that are attached at one end to a catheter tube for insertion into a vein, artery and the like for the removal of plaque and similar material. One or more guide wires may be attached to the woven tube for rotation and a maneuver inside the artery. When the guide wires are retracted, the woven tube expands and contacts the interior, plaque-coated wall of the artery. Movement of the guide wires enlarge the woven tube and will remove the atherosclerotic plaque from the artery to form particles, which are trapped within the tube. An expandable fabric within the woven tube that opens and closes with the corresponding expansion and closure of the woven tube may be used to collect the trapped particles. Luther indicates that removal of the angioplasty device from the artery will then remove the atherosclerotic material from the vein, artery or other type of vessel.
U.S. Pat. No. 4,672,961 to Davies discloses a device adapted to be inserted into a coronary artery and vessels for removing plaque deposits within the artery, a guide wire and a flexible tube. Davies further describes an apparatus and procedure for retrolasing plaque deposits in a coronary artery to remove plaque, a device including a tip assembly on the end of a flexible inner tube retaining optical fibers that are slidable along a guide wire. The tip assembly includes a reflective surface rearwardly of a front face that directs laser energy supplied through the optical fibers in a rearward direction through a window portion to a focal point externally of the tip assembly. The deposit is removed as the tip assembly is moved in a rearward progression back through the deposit.
U.S. Pat. No. 4,654,024 to Crittenden et al. discloses a thermorecanalization catheter and method for use in an angioplasty procedure. The catheter disclosed has a heater fixed on its distal end that is used to melt atherosclerotic plaque to clear an obstruction within an artery. The catheter heater is a tapering cone that discharges heat from its outer, leading edges. In use a guidewire is placed into the lumen of the catheter so that the distal tip of the guidewire extends a few centimeters farther into the heater tip. The catheter is conducted into the appropriate coronary branch by way of the guidewire and the wire is advanced until it meets the impediment. Crittenden et al. further suggests the device is advanced over the wire until the heater contacts the plaque. The heater is then employed and the catheter is advanced as the plaque melts.
U.S. Pat. No. 4,819,632 to Davies discloses a retrolasing catheter and method for retrolasing plaque residue in an artery. The apparatus includes a tip assembly on the end of a flexible inner tube containing optical fibers that are slidable along a guide wire. The tip assembly includes a reflective surface rearwardly of a front face that directs laser energy supplied through the optical fibers in a rearward direction through a window portion to a focal point externally of the tip assembly. The residue is removed as the tip assembly is moved in a rearward progression back through the residue.
Nixon, in U.S. Pat. No. 5,100,426 discloses a catheter for executing an atherectomy operation to remove plaque from an artery. The catheter contains a plaque cutting head having an outer shell of thin flexible substance generally cylindrical in cross-section and shaped to engage plaque in an artery. The outer shell has a plurality of openings through which the plaque will enter the shell as the shell is forced against the plaque. A cutter rotates inside the shell to cut the plaque that enters into the shell into small pieces as the catheter is pushed through an artery. A motor drive elongated drive shaft whirls the cutter.
U.S. Pat. No. 5,741,246 to Prescott discloses an apparatus for application of low level laser energy to a concerned vessel following a balloon angioplasty procedure. The apparatus employs a catheter to be inserted into a vessel, such as an artery. An inflatable balloon surrounds a portion of the catheter neighboring a distal end of the catheter. The catheter is coupled to a tube which provides inflation fluid for inflating the balloon. A malleable pleated sleeve of clear silicone would encompass the balloon. Electrically conductive flexible film strips are embedded in the sleeve. The strips are aligned longitudinally along the outside of the balloon. The strips contain a plurality of vertical cavity lasers connected in series. Power is provided to the lasers via an external power source so that each VCSEL emits approximately 1 to 10 milliwatts of power.
U.S. Pat. No. 6,168,579 to Tsugita describes a filter flush system for transitory placement of a filter in an artery or vein. The system generally includes a guidewire that is inserted within a guiding catheter, which has an occlusion balloon disposed about its distal end. The guidewire has an expandable filter, which can be collapsed to pass through a lumen and distal port of the guiding catheter. A lumen is adapted to receive a variety of endovascular devices, including angioplasty, atherectomy, and stenting catheters. Fluid medium or blood can be infused through the lumen of the guiding catheter to flush embolic material or mobile plaque generated during the endovascular procedures toward the expanded filter deployed downstream from the region of interest.
U.S. Pat. No. 6,241,745 to Rosenthal describes a surgical apparatus and a method to reinstate blood flow capacity to occluded and fractionally occluded arterial vessels. An endarterectomy instrument and associated method are provided. The instrument combines a separation ring with a wire loop at the distal end of a resilient, flexible catheter. The separation ring separates the plaque and the inner wall from a segment of an occluded artery. The wire loop is then constricted around the undesired material. The wire loop of the endarterectomy instrument is used to sever, snare and remove the separated inner arterial wall with the occlusion. The wire loop of the endarterectomy instrument is heated by passing a current through in order to sever the undesired material from the arterial wall. The undesired occlusion is removed along with the inner layers of the artery by snaring the material with the wire loop and removing the instrument from the vessel in a single step.
O'Connor in U.S. Pat. No. 6,398,792 discloses an angioplasty catheter with transducer using a balloon for focusing of ultrasonic energy for the procedure. The catheter is inserted into an artery having deposits of plaque and/or thrombus. The catheter includes, at its distal end, an ultrasonic transducer and a dilatation balloon surrounding the transducer such that when the balloon is positioned in the artery adjacent the deposits and inflated, energizing of the ultrasonic transducer will focus the ultrasonic energy against the deposits to cause dissolution of the thrombus into microscopic particles and cause cracking and softening of the plaque. O'Connor further describes the provision of a second ultrasonic transducer as a means for viewing the treatment site, and a second balloon to cooperate with the first balloon to define a chamber between the balloons and with a lumen and a port connected to the chamber to remove any debris of larger than microscopic size which might otherwise tend to move downstream and cause further obstructions. Also described is the use of an expandable filtering device distal of the dilatation balloon for trapping such particles. Subsequent to the ultrasonic radiation of the deposits, the dilatation balloon can be further inflated to force a stent into the wall of the artery.
In U.S. Pat. No. 6,620,148, Tsugita describes a filter flush system for transitory placement of a filter in an artery or vein. The system ordinarily includes a guidewire insertable within a guiding catheter, which has an occlusion balloon disposed about its distal end. The guidewire has an expandable filter, which can be collapsed to pass through a lumen and distal port of the guiding catheter. The lumen is adapted to receive a variety of endovascular devices, including angioplasty, atherectomy, and stenting catheters. Fluid medium or blood can be infused through the lumen of the guiding catheter to flush embolic material or mobile plaque generated during the endovascular procedures toward the expanded filter deployed downstream from the region of interest. Methods of using the filter flush system to entrap and remove embolic material from the vessel are also disclosed.
U.S. Pat. No. 6,786,896 to Madhani et al. discloses a method of performing surgery, comprising: using a remotely-controlled robotic surgical instrument having an elongate shaft with a longitudinal axis and a distal end, said distal end coupled to a wrist element. The wrist element fiber is coupled to an end effector, the wrist element has a plurality of wrist segments pivotally jointed together, tracks the motion of a moving portion of a patient's beating heart. The device has at least a portion of the wrist element to permit the end effector element to track motion of the moving heart portion without moving the longitudinal shaft of the instrument.
U.S. Pat. Nos. 6,926,670 and 6,968,743 disclose devices including an implantable microfabricated mechanism capable of being entirely implanted within a human body; the devices including biocompatible monolithic structure.
In U.S. Pat. No. 6,926,670, Rich et al. discloses an implantable microfabricated sensor device and method for measuring a physiologic parameter of concern within a human body. The implantable gadget is a micro electromechanical system (MEMS) device and includes a substrate having an integrated inductor and one sensor created.
Rich et al., U.S. Pat. No. 6,968,743 discloses a device that also relates to the field of micro-electromechanical systems (MEMS) sensors, in which a MEMS capacitive sensor is optimized for implantation into the body of a patient to enable measurement one or more physiologic parameters.
In U.S. Pat. No. 7,607,440, Coste-Maniere, et al. describes methods and a device for enhancing surgical planning to provide enhanced planning of entry port placement and/or robot position for laparoscopic, robotic, and other minimally invasive surgery. Various embodiments may be used in robotic surgery systems to identify advantageous entry ports for multiple robotic surgical tools into a patient to access a surgical site. Generally, data such as imaging data is processed and used to create a model of a surgical site, which can then be used to select advantageous entry port sites for two or more surgical tools based on multiple criteria. Advantageous robot positioning may also be determined, based on the entry port locations and other factors. Validation and simulation may then be provided to ensure feasibility of the selected port placements and/or robot positions. Such methods, apparatus, and systems may also be used in non-surgical contexts, such as for robotic port placement in munitions diffusion or hazardous waste handling.
U.S. Pat. No. 7,647,831, Corcoran et al. describes a method for measuring pressure inside an anatomical fluid system. The method ascertains fluid pressure inside a vessel without compromising the integrity of the vessel. A sensor is positioned in operative communication with the external wall of the vessel such that expansion of the external wall of the vessel exerts a force against the sensor that is directed substantially radially outward with respect to the vessel. A substantially radially inward force is caused to be directed against the sensor in response to the substantially radially outward force exerted by the external vessel wall. The sensor can thus be used to detect the magnitude of the substantially radially outward force. The apparatus includes a sensor and a band operatively associated with the sensor and configured to at least partially encircle the vessel so as to retain the sensor in operative communication against the external wall of the vessel.
Fonseca et al. in U.S. Pat. No. 7,699,059 discloses an implantable wireless sensor. The sensor is a wirelessly controlled, unpowered, micromechanical, flexible sensor that can be delivered using endovascular techniques, to measure a corporeal parameter such as pressure or temperature. A sensor is introduced into the body by the steps of folding or rolling the sensor into a cylinder, loading it into a catheter, and deploying into an aneurysm sac, then allowing it to unroll or unfold, either by itself or facilitated by the incorporation of a super-elastic alloy component.
Joy et al., U.S. Pat. No. 7,839,153 discloses an invention that communicates with a wireless sensor implanted within the human body to measure a physical condition. The invention determines the resonant frequency of a sensor by adjusting the phase and frequency of an energizing signal until the frequency of the energizing signal matches the resonant frequency of the sensor. The system energizes the sensor with a low duty cycle, gated burst of RF energy having a predetermined frequency or set of frequencies and predetermined amplitude. The energizing signal is coupled to the sensor via magnetic coupling and induces a current in the sensor, which oscillates at the resonant frequency of the sensor. The system uses a pair of phase locked loops to adjust the phase and the frequency of the energizing signal.
Prisco et al., U.S. Pat. No. 7,899,578 discloses an invention that relates to medical robotic systems. This type of invention indicates the improvements with respect to medical robotic systems such as those used in performing minimally invasive surgical procedures. It is now becoming more common that robotic procedures offer many benefits over traditional open surgery techniques. Because of robotic surgical procedures, the advantages of: less pain, shorter hospital stays, quicker return to normal activities, minimal scarring, reduced recovery time, and less injury to tissue. Consequently, demand for minimally invasive surgery using such medical robotic systems is strong and growing.
Lamprecht et al., U.S. Pat. No. 7,907,166, discloses a robotic surgical system comprising: a master control console having a stereo viewer to view stereo images of a surgical site; a surgical manipulator coupled to the master control console to receive control signals, the surgical manipulator including a first robotic arm and a second robotic arm, a surgical instrument coupled to the first robotic arm, and a stereo endoscopic camera coupled to the second robotic arm, the stereo endoscopic camera responsive to the control signals to generate stereo video images of the surgical site; a stereo telestration system coupled between the stereo endoscopic camera and the stereo viewer; and a telestration generator coupled to the stereo telestration system. The telestration generator generates telestration graphics for overlay on the stereo images of the surgical site; wherein the stereo telestration system is configured to generate left and right images of the telestration graphics by effectively positioning the telestration graphics at a desired depth relative to the stereo images of the surgical site by adjusting a disparity between the left and right images of the telestration graphics and combine the left and right images of the telestration graphics with corresponding left images and right images of the stereo images of the surgical site for stereo viewing of the telestration graphics with the stereo images of the surgical site in the stereo viewer.
Allen et al. in U.S. Patent Application Publication No. US 2007/0210786 discloses an invention that determines the resonant frequency of a sensor by adjusting the phase and frequency of an energizing signal until the frequency of the energizing signal matches the resonant frequency of the sensor. The system energizes the sensor with a low duty cycle, gated burst of RF energy having a predetermined frequency or set of frequencies and predetermined amplitude. The energizing signal is coupled to the sensor via magnetic coupling and induces a current in the sensor, which oscillates at the resonant frequency of the sensor. The system receives the ring down response of the sensor via magnetic coupling and determines the resonant frequency of the sensor, which is used to calculate the measured physical parameter. The system uses a pair of phase locked loops to adjust the phase and the frequency of the energizing signal.
Hasser et al. in U.S. Patent Application Publication No. US 2007/0167702 discloses a medical robotic system that provides 3D telestration over a 3D view of an anatomical structure by receiving a 2D telestration graphic input associated with one of a pair of stereoscopic images.
Many deaths have been reported due to blockage of human vessels, accordingly, there is a need in the art for less invasive repair procedures for repairing patient vessel obstruction and other defects in arteries such as the aorta or other arteries or vessels.
There is a continuing need for improvement with respect to methods, systems and devices for executing angioplasty procedures, preferably improvement that do not require major surgery, or continued use of drugs and which may be used on higher risk patients than what conventional angioplasty surgery currently allows.